Provider Demographics
NPI:1992043715
Name:VIERA, VIRGINIA G (PA-C)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:G
Last Name:VIERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11251 HERON BAY BLVD
Mailing Address - Street 2:3416
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1653
Mailing Address - Country:US
Mailing Address - Phone:954-531-9312
Mailing Address - Fax:
Practice Address - Street 1:12012 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7000
Practice Address - Country:US
Practice Address - Phone:954-435-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104975363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical